Applicator for surgical clips

ABSTRACT

A hand-operated applicator for use with surgical clips, such as wound clips, comprising a pair of elongate members, one of which is capable of axial movement within a longitudinal cavity in the other, and a pair of jaws projecting from the cavity resiliently biased into an open position and connected to the inner elongate member so that the said axial movement causes the jaws to close against the bias. Clips are fitted into the jaws, preferably from a magazine. The applicator can be made entirely from plastic material but it may be preferred to make the small jaw members from steel. The cost could be low enough to allow the applicator to be supplied pre-sterilised and thrown away after one operation.

United States Patent 11 1 Weston 5] Nov. 27, 1973 [54] APPLICATOR FORSURGICAL CLIPS 2,406,393 8/1946 Neugass 128/354 [75] inventor: DavidFrederick Weston, Runcorn, F REIGN PATENTS R APPLICATIONS England 66,5393/1948 Denmark 81/345 [73] Assignee: Imperial Chemical Industries 321 13 L'mited London England 93 2/1 46 8 V 1 956,354 11 1947 22 i July 1970962,626 7/1964 Great Britain 128/354 [21] Appl' 56519 PrimaryExaminerChar1es W. Lanham Assistant ExaminerE. M. Combs 30 F i A li tipriority Data Attorney-Cushman, Darby & Cushman J l 29 1 69 B u y 9Great ntain 37,944/69 [57] ABSTRAC 52 US. Cl 72/410, 81 43, 128/326 Ahand-Operated applicator for use with surgical clips, 51 1m. 01. B2ld9/08, Bb 9/02, A6lb 17/12 Such as wound clips, Comprising a p ofelongate [58] Field of Search /123, 134, 181; members, one of which isCapable of axial movement 72/409 410; 1/43 342 345 9 5 2 within alongitudinal cavity in the other, and a pair of 23 321 322 330 3 /106jaws projecting from the cavity resiliently biased into an open positionand connected to the inner elongate [56 R fe Cited member so that thesaid axial movement causes the UNITED STATES PATENTS jaws to closeagainst the bias. Clips are fitted into the jaws, preferably from amagazine. The applicator can 'gif be made entirely from plastic materialbut it may be 3140715 H1964. 128/321 preferred to make the small jawmembers from steel. 3:518:993 7 1970 Blake .I :1: 128 321 The cost mumbe low enough allow the applicam 3,255,880 6/1966 Grossman 206/632 R tobe Supplied inc-sterilised and thrown y after 3,561,918 2/1971 Ray2l/DIG. 4 one Operation- 774,142 11/1904 Brick 30/181 1,633,237 6 1927Whitl0w.. 81/345 1 Clam 5 Draw"; F'gures 1,714,822 5/1929 Sega] 81/43FMENTEU NOV 2 7 I975 SHE! 2 [F gical. clips such as artery clips or thelike.

Clips with which this invention is concernedv com,-

prise small, substantially V-shaped pieces of-metal or the like whichmay be deformedby moderateforce so as to cause the arms of the V' tocome toget erand'to remain in thisdeformed position, thus clampinganartery or the like located between the arms of the V. Clips of thistype will hereinafter be referred to as deformable clips or, simplyclips.

-It is current surgical practice to use small,inert(e.g., of tantalum,stainless steel or silver).deformable metal clips, to holdtogetherwound-edgesror to-clarnparteries before they are severed in: surgicaloperations. The clamping of arteries, for example, iscommonly performedby manually inserting adeformable clip in. a pair of sterile forceps,andthendeformingathe clip into its clamping position by means of theforceps. I

The forceps commonly used are precision; made in surgical qualitystainless steel and have to be resterilised between surgicaloperations.'li'hus they have a high initial cost plus the recurrent costincurred-in,

successive sterilisations. Attempts to use disposable plastics forcepsfor this purpose have not proved entirely satisfactory, asitisdifficultto make them sufficiently robust while maintaining.aesthetically acceptable to the surgicalprofession. The mainlimitationin streamliningthe design of the aforementioned plasticsforceps resides in accommodating the large bending moments whichhave to.be wiflistoodibythearmsof the forceps. t I

.We have now devisedaan applicatorsuitable for use with clips of thetype referredtoin which only compressive and tensilev stresses aregenerated in the activating members, thus. enabling a slimmer: designto'- be used, especially when constructedifromplastics,materials.

According to the present invention, an: applicatonfor use with asurgical clip of the type referred to comprises a pair of elongatemembers, one of which fits within an elongate cavity in the other and.is capable of.

axial movemnt therein, means for causing'relative" axial movementbetween the two members, and means'bywhich a pair of movable jaws areretainable within-said cavity with one end of each jawprotrudingfrom-thecavity, its other end being engagable withv the inner member so that thejaws execute alsimilar axialmovement therewith, the walls of 'thecavitybeing, provided with bearing surfaces adaptedto co-operate with corresponding surfaceson-the jaws whereby thesaidrelative axial movementcauses the jaws-to eometogetherin. a gripping motion.

The jaws may be permanently retained within-the cavity in permanentengagement with the inner member and, in-some embodiments,may-'be-formediintegrally. with it. Preferably the jawsare resilientlybiassed into an open position sothatappliedrelative axial movement isonly required in: the gripping, direction, the returnmovement beingcaused'by the-said bias.

This bias is conveniently achieved by theprovisionof a resilient memberbetween the jaw members but remote fromtheirgripping surfaces.

The co-operating, surfaces of jaws andrcavity'may comprise inclined;planes, or tapers, *havingsimilar inclination to minimise frictionalforcesbetweenthe'two.

. other fibres or filaments. The final choice of material Forexample, ifthe cavity is provided with an outwardly facing taper, the jaws may beclosed by drawing them into the cavity, whereasin the case of a cavityhaving an inwardly facing taper the jaws may be closed by eitpellingthem slightly from the cavity. It will be appreciated that either thejaws or the cavity along may be provided with a taper.

' Any suitable means may be used for causing relative axial movementbetween the two elongate members, the choice being largely dependentupon whether the device is intended to be hand or power operated. Itwill also depend on whether the design requires the inner member to bepulled or pushed to efi'ect closing of the aws.

. v The applicator may be constructed mainly or totally from plasticsmaterials, two or three mouldings generallysufficing. Thesemay beadapted to interlock or may be secured together by some simple assemblytechnique, such as welding or riveting which is readily adapted tomass-production. However, it is possible to form our applicators as onepiece plastics mouldings.

Suitable plastics materials include polypropylene, polystyrene,polyethylene, and poly(4-methyl pentene- 1)and their copolymers, A.B.S.copolymers, and polyarnides with or without reinforcement, such as glassor will depend upon the stresses liable to be generated in.thezparticular partof the device for which itis used; for example,polypropylene is very suitable for any part .whichis required: towithstand repeated flexure, whereas a reinforced material, e.g., glassfibre filled nylon is desirable if plastics materials are usedfor thejaws. When. this is done, itis possible toformthe inner member and: twojaw members from a single piece of plastics material.

when separate jaw members are used, they may be formed, for example,with inwardly pointing hook-like ends-adaptedto be located within thecavity in the outer member so as to engage with recesses in the innermember which enable them to pivot andthus accom- Lbe sterilised betweenoperations, the remainder being disposable. This may represent aworthwhile saving in sterilisation time, as the jaws are small and maybe readily designed to be free of narrow crevices in whichbacteria'andthe like might lodge. However, since the clips used may beassmall as 4 mm in length, the jaws need be only some mm long and 6sq.mm. in crosssection and are readily mass-produced. Thus, even whenconstructedfrom, for example, surgical quality stainless steeltheir-cost may be small compared with the cost of repeatedre-sterilisation, so that plastic applicators with metal jawsconstructed according to our invention may be cheap enough tobedisposable.

It is, of course, within the scope of our invention that the wholeapplicator may be constructed of surgical quality stainless steel orthelike to enable it to be resterilised many times.

1 Applicators according to our invention may be made in-a very slimform, even in plastics materials, and may be designed to be used withouthand movement across the line of sight, unlike forceps and otherapplicators of the scissors type. Thus it is possible for ourapplicators to allow access to very narrow cavities such as arefrequently encountered in, for example, brain surgery and to cause aminimum of obstruction of the surgeons vision.

It will be appreciated that when our applicators are produced as asingle plastics article, e.g., a one-shot moulding, the articlepreferably comprises two elongate portions which are adapted toco-operate to define a cavity in which an inner member may move axially-Such an article may comprise a central elongate inner member, flanked bya pair of elongate cavity-forming members which are capable ofco-operating to form an outer member which encloses the said innermember, the three members lying substantially parallel over most oftheir lengths, one end of each member issuing from a common, integraljunction, so that the article has a generally tri-furcated appearance.

The cavity-forming members are preferably designed so as to snaptogether by means of co-operating grooves, ridges, studs or likeexpedients which make use of the natural resilience of the plasticsmaterial, to facilitate assembly of the applicator. If the jaws of theapplicator are also to be of plastics material, these may be formedintegrally with the rest of the device. When this is done, the plasticsmaterial must be chosen so that it possesses sufficient rigidity for thejaws to deform the clip. It has been found, for example, that nylonfilled with 40 percent by volume of glass fibre is a suitable materialfor such applicators.

In order that the invention may be more clearly understood, threeembodiments of our invention will be described, by way of example onlywith reference to the accompanying drawings of which:

FIG. 1 is a sectional elevation of one form of applicator;

FIG. 2 is a partly cut-away isometric view of a second form ofapplicator;

FIG. 3 is an isometric view of a third form of applicator of one piececonstruction;

FIG. 4 is a section through the assembled applicator of FIG. 3 on theline IVIV; and

FIG. 5 is an enlarged view of the end of a jaw of one of ourapplicators.

Like reference numberals are used throughout to designate like parts.

Referring to FIGS. 1 and 2, outer elongate member 1 is formed frompolypropylene and provided with internal cavity 2 within which innerelongate member 3, also formed of polypropylene, is a sliding fit. Innermember 3 is provided near one end with recesses 4, which accommodatehook-like extremities 5 of metal jaws 6. Beyond recesses 4 but at thesame end of inner member 3, integral V-shaped protuberance 7 serves tobias jaws 6 resiliently towards the inner surfaces of cavity 2.Co-operating surfaces 8 of jaws 6 and cavity 2 are provided withmatching inclined planes which, in the embodiment shown in FIG. I, serveto force jaws 6 together when inner member 3 is moved towards the leftof the drawing, and in the embodiment shown in FIG. 2, movement ofmember 3 towards the right has a similar effect.

The end of inner member 3 remote from jaws 6 protrudes past thecavity-defining part of outer member 1. In the case of the embodimentshown in FIG. 1, a U- shaped band of propylene 9 links inner member 3 toouter member 1. Hand pressure applied across the limbs of the U, asindicated by arrows A, causes the tips of jaws 6 to come together in agripping action as indicated in broken lines. In the case of theembodiment shown in FIG. 2, the outer extremity of inner member 3 issecured, e.g., by bonding or riveting, to the end 10 of polypropyleneloop 11 which is formed integrally with outer member 1. Hand or fingerpressure applied across loop 11, as indicated by arrows B, has theeffect of closing the tips of jaws 6 in this embodiment.

Referring to FIG. 3, the applicator illustrated is of the same generalform as that of FIG. 2 with the exception that it comprises a singlepiece of nylon reinforced by 40 percent by volume of glass fibre toimpart the necessary regidity to the jaws 6. However, outer member 1comprises two U-sectioned members 1A and 1B which may be snappedtogether as shown isometrically in broken lines in FIG. 3 and in sectionin FIG. 4, to form cavity 2 in which inner elongate member 3 may slide.Cavity forming members 1A, 1B are retained in position by the snapaction provided by the co-operation of ridges 12, 13 on their innersurfaces. Members 1A and 1B are located near the extremities of elongatemembers 11 which serve the same purpose as loop 1 l in the embodimentillustrated in FIG. 2.

In the embodiment shown in FIG. 3 elongate members 11 and inner member3, being part of a single piece of nylon, are joined integrally throughbridging member 10. Jaws 6 are formed integrally with inner member 3being biassed into an open position by the natural resilience of thematerial. When fully assembled, this embodiment operates in a similarfashion to that shown in FIG. 2, with the exception that the bearingsurfaces 8 of cavity 2 are not provided with tapers. It will beappreciated however, that it is possible for form applicators of thisgeneral type, but having detachable metal jaws by omitting the jawmembers from the end of member 3 and substituting them by recesses 4 andV-shaped protruberance 7, as shown in FIG. 2.

The inner, or gripping, surfaces of the jaws are preferably providedwith longitudinal grooves to facilitate alignment of the clip duringapplication. Because of the scale of the drawings, these grooves are notshown in FIGS. 1 to 3; but they are illustrated in FIG. 5 which is ascrap view of one jaw on a much enlarged scale. Referring to FIG. 5, jaw6 is provided on its inner surface with longitudinal groove 14 intowhich one leg of an undeforrned V or U-shaped clip may be fitted. Thejaw illustrated in FIG. 5 is further provided with a transverse groove15 designed to accommodate a protrusion or like discontinuity in the legof the clip so as to locate it in a longitudinal direction with respectto the jaws. Instead of groove 15 it is possible to provide a localconstruction in the width of groove 14 which will cooperate with asuitably positioned constriction in the leg of the clip. Clips havingsuch protruberances or constrictions are described and claimed in ourcopending patent applications.

In use a V or U-shaped clip 12 (see FIG. 1) of stainless steel or othersurgically acceptable material is fitted into grooves 14 (see FIG. 5) inthe inner surface of jaws 6. Clip 12 is then arranged to straddle anartery or the like and deformed into a gripping or clamping position byoperation of the jaws of the applicator as described above. On releaseof pressure from the appropriate part of the applicator, jaws 6 openunder the bias of resilient member 7 or under the influence of thenatural resilience of the material to enable them to receive anotherclip.

Although the invention has been illustrated by reference to metal arteryclips, it may be used equally well with clips of other surgicallyacceptable materials.

As previously mentioned, applicators according to our invention may besupplied pre-sterilised and discarded after use. Sterilisation may beconveniently performed after packing the applicators in an air-tightplastics bag, by mean of irradiation or ethylene oxide treatment.

What we claim is:

1. An applicator for use with a surgical clip which comprises inner andouter elongate members, one of said elongate members fitting within anelongate cavity in the other and being capable of axial movementtherein, means for causing relative axial movement between the twomembers and a pair of jaws located within said cavity with one end ofeach jaw protruding from the cavity, the other end of said jaw beingengageable with the inner member so that the jaws execute a similaraxial movement therewith, the walls of the cavity being provided withbearing surfaces which axially slidably cooperate with correspondingsurfaces on the jaws whereby the said relative axial movement causes thejaws to come together in a gripping motion, the said means for causingrelative axial movement between the elongate members comprising aloop-like extension of only the outer member disposed remote from thejaws, said extension comprising a pair of outwardly bowed, resilientlimbs of the outer member which straddle the inner elongate member, theouter ends of the limbs and the outer end of the inner member beingcoupled together so that inward pressure on said bowed limbs causes thedesired relative axial movement to simultaneously effect operation ofjaws, said applicator comprising a single plastic article having agenerally trifurcate appearance, comprising a central elongate innermember flanked by a pair of elongate cavityforming members havinginterfitting, channel-shaped outer ends which are provided withoo-operati ng ridges on their inner surfaces for locking said ends inassembled relationship to form an outer member in which the said innermember is a sliding fit, the three said elongate members lyingsubstantially parallel over most of their lengths, one end of eachmember issuing from a common, integral junction.

1. An applicator for use with a surgical clip which comprises inner andouter elongate members, one of said elongate members fitting within anelongate cavity in the other and being capable of axial movementtherein, means for causing relative axial movement between the twomembers and a pair of jaws located within said cavity with one end ofeach jaw protruding from the cavity, the other end of said jaw beingengageable with the inner member so that the jaws execute a similaraxial movement therewith, the walls of the cavity being provided withbearing surfaces which axially slidably cooperate with correspondingsurfaces on the jaws whereby the said relative axial movement causes thejaws to come together in a gripping motion, the said means for causingrelative axial movement between the elongate members comprising aloop-like extension of only the outer member disposed remote from thejaws, said extension comprising a pair of outwardly bowed, resilientlimbs of the outer member which straddle the inner elongate member, theouter ends of the limbs and the outer end of the inner member beingcoupled together so that inward pressure on said bowed limbs causes thedesired relative axial movement to simultaneously effect operation ofjaws, said applicator comprising a single plastic article having agenerally tri-furcate appearance, comprising a central elongate innermember flanked by a pair of elongate cavity-forming members havinginterfitting, channel-shaped outer ends which are provided withco-operating ridges on their inner surfaces for locking said ends inassembled relationship to form an outer member in which the said innermember is a sliding fit, the three said elongate members lyingsubstantially parallel over most of their lengths, one end of eachmember issuing from a common, integral junction.